Ovarian Cancer Surveillance

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Dear OncoLink "Ask The Experts," I am a 33-year-old female and have had treatment for CIN1 cells, which affected 3/4 of my cervix. I also have had my mother and grandmother die from ovarian cancer. I have been advised that I should have DNA testing to determine if I carry "The Gene". Upon going to the Genetics Specialist, was advised testing would take 1 year and as I was only 30 years old and no children, testing would be better suited to me after I had a family and or at age 35. I have since had one child. I have been having annual CA125 and Intravaginal scans. If I have the gene fault, is my only option to have a full hysterectomy, as I have been advised? Is my early detection program sufficient?

Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:

Your questions raise some very complex issues. Although most ovarian and breast cancer has nothing to do with heredity, approximately 10% of cases occur in patients with genetic abnormalities (mutations) that predispose to cancer. Most of these abnormalities are in the BRCA1 and BRCA2 genes. Women with such abnormalities have a much-increased risk of getting both breast and ovarian cancer. Fortunately, fairly accurate genetic testing is now available to identify carriers of these mutations. Because most BRCA-related cancers do not occur until after age 35, testing may not be offered to younger women. For women with documented (or strongly suspected) gene mutations, a program of surveillance for breast and ovarian cancer is recommended. Once women have completed childbearing, most authorities recommend prophylactic removal of the ovaries, which will markedly reduce the
risk of a subsequent ovarian cancer, and reduce the risk of breast cancer as well. I would suggest that you return to see the genetic counselor to review your situation. Your Pap smear problem is unrelated, although it could affect the decision to remove the uterus or not if prophylactic
surgery is done.